Maximum Number of 96367's we can bill

I recently heard that we can only bill a maximum of 3 - 96367's on a claim. Does anyone know how to bill 4 pre-meds prior to chemotherapy?

re: Maximum Number of 96367's we can bill

The three unit limit was put in place by Medicare at the beginning of the year (the super secret "Medically Unlikeley" edits). Due to immediate outcry from oncology organizations, it is supposed to be rescinded April 1st, after which time you should be able to request adjustment to pay the 4th unit(s). Or, you can follow COA's advice: "until April 1, 2012, your members reporting more than 3 UOS (units of service) of medically reasonable and necessary sequential infusions of new drugs/substances can use the method that I previously described reporting the code on two lines of a claim appending modifier 59 to the code on one line and dividing the total UOS between the two lines.”

re: Maximum Number of 96367's we can bill

The Centers for Medicare and Medicaid Services (CMS) had put in place a Medically Unlikely Edit (MUE) effective January 1, 2012, limiting sequential infusions to a maximum of three substances. This is being corrected, a temporary change in the MUE value for this code in the April 1, 2012 version. The change will be retroactive to January 1, 2012. The new value, like the previous value is a confidential, unpublished value. A provider may appeal the claim line denial to his local claims processing contractor.